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Evaluating peer support is important for designing peer support programs (e.g., training outcomes of peer supporters), understanding what peer support looks like (e.g., delivery of peer support events), and demonstrating program impact (e.g., quality of life, health outcomes). Knowing “when, how, and what to evaluate” is very important. In many cases, answers to these questions can be critical to program sustainability.

In general, program evaluation starts with planning to make sure what you are going to measure answers not only the question of “did peer support work”, but also “how it worked”.  Overall, it is crucial to identify reliable measures, indicators, tools, and instruments that are relevant to overall program goals, objectives and activities.

Measuring the Benefits of Peer Support for Self Management in Diabetes:  Peers for Progress Consensus Evaluation

Starting in 2009, Peers for Progress funded eight evaluation grants to conduct their own research projects testing the effectiveness of peer support in management of type 2 diabetes.  These individual sites also pooled data into a cross-site evaluation.  Investigators and key staff collaborated with the Peers for Progress Program Development Center at the University of North Carolina at Chapel Hill to identify key evaluation indicators of their peer support programs that could be applied across all projects.  The aim was for a core set of shared evaluation indicators that could strengthen evidence from, yet not add burden to, their individual and collective projects assessing the impacts of peer support.

The following consensus set of shared measures from the Peers for Progress Evaluation Grants include clinical, behavioral, quality of life, process evaluation, mediator/moderator, and costs items.  These measures are selected to be (or be readily modifiable to be) of general applicability in adult health care, chronic disease management, and health promotion, not just diabetes management.

CategoryMeasures, Indicators, Measurement Tools
Clinical endpoints and demographic measures to describe study populationOn insulin / other injectables / oral agents, initiation, dose; HbA1c, blood pressure, weight; age, sex, height, year of diagnosis, highest education, marital status
Behavioral measures (including medication adherence)Selections from Summary of Diabetes Self Care Activities, Behavioral Risk Factor Surveillance System (BRFSS), and Morisky Scale (4-item)
Quality of LifeEQ5-D (general); Diabetes Distress Scale (2-item screen); PHQ-8 (depression)
Process EvaluationPerceived Availability of Peer Support by core functions and sub-elements
Mediators and ModeratorsHealth literacy; Support from family, friends, and health care team; Non-directive vs. Directive Support (8-item)
CostsSystem costs (clinic, hospital, ED visits)

Planning Your Evaluation: RE-AIM Model

This evaluation framework (outlined below) includes and goes beyond a sole focus on the “did it work?” question to help expand our understanding of and translate effective health promotion and behavior change interventions.

According to RE-AIM, evaluations should examine five dimensions:

  • Reach into the target population;
  • Efficacy or effectiveness of the intervention;
  • Adoption by target settings or institutions;
  • Implementation-consistency of delivery of intervention; and
  • Maintenance of intervention effects in individuals and populations over time.

Researchers and community leaders can visit the RE-AIM website for additional background and resources for evaluation.

View the RE-AIM Planning Tool to help in planning your evaluation.

In addition to RE-AIM, the following resources may also be helpful for a comprehensive approach to evaluation:

Impact and Outcome Evaluation

According to a 2007 WHO report, there are several key indicators of the effectiveness of a peer support program. These indicators of success help assess:

  • The immediate effect a program has on target behaviors and their influencing factors (internal or external): Impact Evaluation
  • The effect of a program on health status and quality-of-life indicators: Outcome Evaluation

Impact Evaluation Indicators identified by the WHO report are:

  • Self-reported quality of life and emotional distress
  • Adherence to behavioral and medication prescriptions
  • Knowledge, attitudes, self-efficacy, autonomy and ability to function in their life roles and at work or school

For diabetes peer support programs, tools that can be used to assess behavioral measures include:

Tools that are often used to assess Quality of Life include:

Outcome Evaluation Indicators identified by the WHO report can be categorized into:

Clinical parameters such as:

  • Presence or absence of symptoms (hypo or hyperglycemia)
  • HbA1C
  • Cardiovascular risk factor control
  • Hospitalizations and emergency room visits
  • Health care resource consumption
  • Presence or development of long term diabetes or cardiovascular complications
  • Expenses (costs) and savings (benefits) associated with the program

Additional indicators such as:

  • BMI (Body Mass Index)
  • Cholesterol
  • Blood Pressure

Learn more about Impact and Outcome Evaluation

Documenting Peer Support Delivery: Process Evaluation

Process evaluation assesses how a program is implemented. It takes into account all program inputs (e.g. theoretical foundations, goals and objectives, resources, etc.), activities (e.g. training, peer support interactions, etc.), and reactions of participants and stakeholders. Some areas you might consider assessing during a process evaluation are:

  • Context: what are aspects of the community or environment that might influence the program?
  • Reach: who is participating?
  • Dose Delivered: how are peer supporters trained?
  • Dose Received: what happens in interactions between peers supporters and participants?
  • Fidelity: was the program delivered as planned (training and peer support interaction)?

Some ways you might measure process evaluation questions are:

  • Interviews or questionnaires with peer supporters, participants, or stakeholders
  • Observation of trainings or peer support interactions
  • Administrative bookkeeping

Learn more about Process Evaluation

* Complete reference for the book chapter by Linnan and Steckler

  1. Linnan, L., and Steckler A. (2002). Process evaluation and public health interventions: An overview. In: Steckler, A., and Linnan, L (Eds.), Process Evaluation in Public Health Interventions and Research. San Francisco: Jossey-Bass Publishers. (pgs. 1-23).
  2. Steckler, A., and Linnan L. (Editors). (2002). Process Evaluation in Public Health Interventions and Research. Jossey-Bass Publishers. (400 pages)

Example Protocols & Tools for Program Evaluation